University of Ghana http://ugspace.ug.edu.gh UNIVERSITY OF GHANA CULTURE AND ENFORCEMENT OF CODE OF ETHICS IN THE GHANAIAN CIVIL SERVICE: EXPERIENCES FROM THE HEAD OFFICE OF THE MINISTRY OF HEALTH (MOH) BY CONSTANCE QUAYE (10636637) A LONG ESSAY SUBMITTED TO THE UNIVERSITY OF GHANA, LEGON IN PARTIAL FUFILMENT OF THE REQUIREMENTS FOR THE AWARD OF MASTER OF PUBLIC ADMINISTRATION DEGREE JUNE, 2019 University of Ghana http://ugspace.ug.edu.gh DECLARATION I, hereby solemnly declare that this study is entirely my own work; and neither part, nor whole of it has been presented for another degree elsewhere, except where due acknowledgement has been made in the text. ………………………………… ………………………………… CONSTANCE QUAYE DATE (10636637) i University of Ghana http://ugspace.ug.edu.gh CERTIFICATION I, hereby, certify that the preparation and presentation of the work was supervised by me in accordance with the guidelines and supervision of dissertation laid down by the University. …………………………………………………. …………………………………. THOMAS BUABENG (PhD) DATE (SUPERVISOR) ii University of Ghana http://ugspace.ug.edu.gh DEDICATION This work is dedicated to my parents and my family. iii University of Ghana http://ugspace.ug.edu.gh ACKNOWLEDGEMENT This study would not have been possible without God’s grace. My in-depth and heartfelt gratitude to my supervisor Dr. Buabeng. His constant corrections, particular attention to details has enabled me to present a very detailed work. Every meeting to discuss the state of my work resonated in me new ideas helping me get a clearer picture and a better understanding of my findings. A big thank you to Tema International School and Dr. Mrs. Sylvia Boye for the opportunity to go back to school without which doing a research wouldn’t have materialized in the first place.I am also grateful to the Ministry of Health, headquarters in Accra for the respondents’ assistance to fill my questionnaire. My sincere acknowledgements to all scholars who made my references possible. Also a very big thank you to Dr. Mrs. Cecilia Akita of the United Nations (FAO), Mr. Nortey (Kystle’s Pastries East Legon) Ms. Adih, Mrs.Essuman, Ms.Koree, Ms. Atsor, Mr. Lartey, Mr. Ayisi, Mr. Hayibor for their countless support when I felt frustrated and overwhelmed with the demands of my work and wanted to quit the project. Not forgetting Ms. Hanson of Ghana International School, MPA class of 2019 especially Mr. Commodore, and the Awuku-Lokko’s for pushing me to go the extra mile when I became tired. Finally, a very big thank you to the host of family members, friends and my parents who showered me with all the love and care helping me finish this programme successfully. iv University of Ghana http://ugspace.ug.edu.gh TABLE OF CONTENTS “DECLARATION” ........................................................................................................................ 1 "CERTIFICATION” ....................................................................................................................... ii "DEDICATION” ........................................................................................................................... iii ACKNOWLEDGEMENT ............................................................................................................. iv TABLE OF CONTENTS ............................................................................................................... iv LIST OF TABLES ....................................................................................................................... viii ABSTRACT .................................................................................................................................... x CHAPTER ONE ............................................................................................................................. 1 GENERAL INTRODUCTION ....................................................................................................... 1 1.0 Introduction and Background ................................................................................................... 1 1.1 Problem Statement .................................................................................................................... 2 1.2 Research objectives ................................................................................................................... 3 1.3 Research questions .................................................................................................................... 3 1.4 Relevance of the study .............................................................................................................. 4 1.5 Chapter Outline ......................................................................................................................... 4 CHAPTER TWO ............................................................................................................................ 6 LITERATURE REVIEW ............................................................................................................... 6 2.0 Introduction ............................................................................................................................... 6 2.1 The Concept of Ethics ............................................................................................................... 6 2.2 Code of Ethics ........................................................................................................................... 7 2.3 The Concept of Culture ............................................................................................................. 8 2.3.1 Levels of Culture.................................................................................................................... 9 2.4 Codes of Ethics and Ethical Conduct...................................................................................... 11 2.5 Factors Influencing the Enforcement of Code of ethics in Organizations .............................. 12 2.5.1 Leadership ............................................................................................................................ 13 2.5.2 Organizational Ethics or Cultural factors ............................................................................ 13 2.5.3 Culture and Code of Ethics .................................................................................................. 14 2.6 The Civil Service of Ghana..................................................................................................... 16 2.6.1 Civil Service Code of Ethics ................................................................................................ 17 v University of Ghana http://ugspace.ug.edu.gh 2.7 Theoretical Framework ........................................................................................................... 18 CHAPTER THREE ...................................................................................................................... 22 METHODOLOGY ....................................................................................................................... 22 3.0 Introduction ............................................................................................................................. 22 3.1 Research Approach ................................................................................................................. 22 3.2 Case Study Design .................................................................................................................. 23 3.3 Study Organization ................................................................................................................. 23 3.4 Target Population .................................................................................................................... 24 3.5 Sampling Technique ............................................................................................................... 24 3.6 Sample Size ............................................................................................................................. 25 3.7 Data Collection Sources .......................................................................................................... 25 3.8 Data Collection Tools ............................................................................................................. 26 3.9 Data Management and Analysis ............................................................................................. 27 3.10 Ethical Considerations .......................................................................................................... 28 4.0 Introduction ............................................................................................................................. 29 4.1 Cultural factors that influence enforcement of code of ethics at the MOH ............................ 30 4.2 How cultural factors influence the enforcement of codes of ethics in the MOH ................... 32 4.2.1 Attachment to kinsmen; ethnic groups, clans and family relations ..................................... 32 4.2.2 Respect for Age and code of ethics ...................................................................................... 34 4.2.2 Obligations to attend social activities and enforcement of code of ethics ........................... 36 4.2.4 Ghanaian cultural outlook on gender roles and enforcement of codes of ethics ................. 37 4.2.5 Religion and Enforcement of Code of ethics at the MOH ................................................... 39 4.2.6 Disregard for Time ............................................................................................................... 40 4.2.7 The Concept of “Dwantoa” and enforcement of code of ethics .......................................... 41 4.3 Managing cultural influences to ensure effective implementation of code of ethics at the MOH ............................................................................................................................................. 43 4.3.1 Depersonalizing the enforcement of code of ethics ............................................................. 43 4.3.2 Stringent application of the code of ethics irrespective of who it affects or involved ......... 44 4.3.4 Review of the code of ethics to be culturally sensitive to the needs of civil servants ......... 46 4.4 Conclusion .............................................................................................................................. 46 CHAPTER FIVE .......................................................................................................................... 48 SUMMARY, CONCLUSION AND RECOMMENDATIONS ................................................... 48 5.0 Introduction ............................................................................................................................. 48 vi University of Ghana http://ugspace.ug.edu.gh 5.1 Summary of the Study ............................................................................................................ 48 5.1.3 Summary of findings............................................................................................................ 49 5.2 Conclusions ............................................................................................................................. 49 5.3 Recommendations ................................................................................................................... 50 REFERENCES ............................................................................................................................. 53 APPENDICES .............................................................................................................................. 57 vii University of Ghana http://ugspace.ug.edu.gh LIST OF TABLES Table 2.1: Dimensions of Hofstede’s cultural theory ................................................................... 20 Table 4.1: Breakdown of the demographics information of Respondents Source, Fieldwork data 2019 .............................................................................................................................. 30 viii University of Ghana http://ugspace.ug.edu.gh LIST OF ACRONYMS MOH Ministry of Health ix University of Ghana http://ugspace.ug.edu.gh ABSTRACT This study investigated how culture influences the enforcement of code of ethics at the Ministry of Health (MOH).Using the qualitative approach, the case study design option was employed to examine the phenomena in depth. Primary data was collected through in-depth interviews with various officials at the Ministry of Health headquarters in Accra. Through a review of existing documents, reports and other scholarly publications, the primary data was effectively triangulated. Analysis of data was done through the thematic process. The study found that several cultural factors influence the enforcement of code of ethics at the MOH. These include but not limited to, respect for age, gender, religion, obligations to family and other social activities like funerals, festivals, outdooring and the disregard for time.These findings mirror how the cultural orientation of the citizenry influence the manner in which code of ethics are enforced. Thus, the enforcement of code of ethics in dealing with unethical conduct by officials at the MOH is also subject to the cultural factors that exist in the Ghanaian context. The mind-set of the typical Ghanaian is shaped by his cultural outlook. This sometimes possess a challenge with the enforcement of code of ethics. In managing these cultural influences with the enforcement of code of ethics at the ministry, officials adopted various strategies to minimize the unethical practice. These include ethical education for employees, reviewing code of ethics to integrate cultural concerns and stiffer and consistent punishment for offenders to ward off future offenders. x University of Ghana http://ugspace.ug.edu.gh CHAPTER ONE GENERAL INTRODUCTION 1.0 Introduction and Background Civil servants have a number of ethical standards to which they are expected to conform to in the performance of their official duties. These ethical standards are usually expressed in code of ethics, which provide a framework for ensuring acceptable conduct, attitude and behavior by these officials, as they serve the public (Cooper & Yoder, 2002;Menzel, 2014). According to Kumassey, Bawole & Hossain (2017), code of ethics help civil servants solve complex situations, and serve as a compass that indicates the action which should be taken in such situations. However, the enforcement of code of ethics is contingent on several factors. These include individual factors such as personal goals, knowledge and values; organizational factors such as leadership, modes of enforcement and organizational culture; and also, the general culture of the country within which the codes are enforced (Boateng 2018). Of these, the general culture of a country has been found to be very profound in determining the extent to which codes of ethics are enforced (Asamoah et al., 2014; Sakyi &Bawole, 2010). Perry (2015), opines that as part of a unified system (the society), there is an important interplay, and in some cases conflict between codes of conduct, procedures and expectations on one hand and cultural values, norms and practices on the other hand and that affects their application. This suggests that the extent to which ethical codes are enforced, depends on cultural contexts and disposition of the people. 1 University of Ghana http://ugspace.ug.edu.gh In his classic study of the role of culture in organizational behavior, Hofstede (2017) provides an in-depth discussion of culture on employee’s conduct. By defining culture, as “collective programming of the mind which distinguishes the members of one group or category of people from another” (2017), Hofstede suggests that culture connects people in an organization and the nation at large by their philosophies and ideologies and procedures. Therefore, enforcement of ethical standards among civil servants is largely influenced by cultural factors, which include the values, beliefs, norms, and attitudes that underlie them. Hofstede’s work (2017) reinforces the position that the extent to which code of ethics are enforced is very much determined by the cultural milieu of any given country. 1.1 Problem Statement Code of ethics represent the sum of ethical principles and norms, which are obligatory for all employees within the civil service irrespective of their position in the organizational hierarchy (Hope 2016; Sakyi& Bawole, 2010). As in other countries, Ghana has instituted a comprehensive code of ethics for the regulation of all civil servants. Ghana’s code has strict guidelines on personal and professional conduct, information disclosure, gifts and bribes, civil responsibilities and interactions with fellow workers. Although the code is to be enforced to the letter, there is some evidence to suggest that they are not fully enforced in the Ghana’s civil service (Ahenkan, Afari&Buabeng 2018; Osafo, 2016). In spite of these signals, there is paucity of research on the factors that underlie the non-enforcement of codes of conduct within the Ghanaian civil service. This study therefore attempts to fill this gap by investigating the cultural factors that impinge on the application of ethical codes among civil servants in Ghana. Furthermore, a look at the literature reveals some agreement among scholars that the general culture within which ethical codes are implemented influences the extent to which they are 2 University of Ghana http://ugspace.ug.edu.gh enforced in organizations (Boateng 2018; Ohemeng&Asiedu 2016). However, beyond merely establishing the linkages, studies that explore how these cultural practices influence ethical standards in the civil service employees are rather limited. Understanding how these cultural norms influence enforcement of ethical standards will not only contribute knowledge on the role of culture in explaining ethical behavior in the civil services, but also help in generating effective strategies to deal with these cultural tendencies. It is against this backdrop that this study draws on the experiences of the Ministry of Health (MOH), to investigate how prevailing cultural conditions in the Ghanaian setting influence the enforcement of codes of ethics among civil service employees. 1.2 Research objectives The general objective of the study is to investigate how culture influences the enforcement of code of ethics in the MOH. To achieve this broad objective, the following specific objectives are pursued. 1. To determine the cultural factors that influence enforcement of ethical codes at the MOH 2. To investigate how cultural factors, influence the enforcement of codes of ethics in the MOH 3. To understand how these cultural factors are managed at the MOH to ensure effective implementation of codes of ethics. 1.3 Research questions To achieve the research objectives above, the study is guided by the following research questions. 1. What cultural factors influence the enforcement of code of ethics in the MOH? 3 University of Ghana http://ugspace.ug.edu.gh 2. How do these cultural tendencies influence the enforcement of code of ethics in the MOH? 3. How are these cultural influences managed in the MOH to ensure effective enforcement of code of ethics? 1.4 Relevance of the study This study contributes to the literature on ethical standards in organizations. This is in the context of less research on cultural influences on codes of ethics among civil servants. A finding of this study therefore contributes insights on the influence of culture in enforcing ethical standards from the Ghanaian context. In terms of policy, the study directs the attention of policy makers to consider cultural norms when formulating and enforcing code of ethics for civil servants. By its recommendations, the study highlights some of the cultural factors that impede the implementation of code of ethics among civil servants in Ghana. In terms of practice, the study offers practical guidelines and strategies for managing the cultural influences underpinning the enforcement of ethical standards at the MOH and the civil service in general. 1.5 Chapter Outline The study consists of five chapters. Chapter one introduces the study and outlines the issues that make up the research problem. It also outlines the objectives of the study, the research questions significance of the study and this chapter outline 4 University of Ghana http://ugspace.ug.edu.gh Chapter two reviews the theoretical and empirical literature on culture and ethics as a means of providing some background literature for the study. Hofstede’s work on culture is also reviewed as a theoretical framework for the study. In Chapter three, the research methodology used for the study is presented. The chapter has themes on the research approach, study design, population, sampling techniques, sample size, data collection sources and methods, data analysis and ethical considerations. Chapter four presents the results and discussions, while chapter five comprises the summary of findings, conclusion, recommendations, limitations of the study, and directions for future research. 5 University of Ghana http://ugspace.ug.edu.gh CHAPTER TWO LITERATUREREVIEW 2.0 Introduction This chapter focuses on literature that been reviewed by other scholars on this topic. The chapter first reviews the concepts of ethics, code of ethics and culture. Also, the factors that influence the enforcement of code of ethics are discussed. The civil service is also presented with a focus on state of the art of ethical codes of the service. The chapter finally reviews Hofstede’s cultural theory to be used as an appropriate framework to guide data collection and analyses. 2.1 The Concept of Ethics The concept of ethics is subjective and therefore does not have a single definition. In general terms, ethics is defined to mean differentiating between what is right and wrong, which provides the basis for principles of moral behaviour (Velasquez et al., 2010).According to Ardichvili & Jondle (2009, p. 226) ethics refers to what is acceptable and what is not acceptable within a certain context. For Driskill (2018), ethics is the “inquiry into the nature and grounds of morality where the term morality is taken to mean moral judgments, standards, and rules of conduct. These definitions bring ethics close to the concept of morality which is sometimes interchanged for ethics. In trying to draw commonalities between the two concepts, Sakyi & Bawole (2010) indicate that both are not that different because they are both concerned with the distinction between right and wrong. However, Neyroud & Beckley (2001), explain that the difference between the two is similar to the difference between thought and action, and that while ethics is concerned with analysis and reflection on the problems of human conduct, morality is more about the nature of the conduct itself. Thus, ethics provides and sustains the boundaries for 6 University of Ghana http://ugspace.ug.edu.gh morality and the pathways for proper thinking about life choices. Ethics represents rules or principles that inform behavior within a particular culture as exhibited by a particular group or organization (Lentz, 2014). 2.2 Code of Ethics An important means by which organizations streamline the behaviour of employees and ensure ethical conduct among them is by the use of code of ethics. The concept of code of ethics is usually used to convey the same meaning as code of conduct. However, according to Sakyi and Bawole (2010), the two concepts are different and mean different things. “Unlike codes of conduct, codes of ethics are reasonably general, encouraging groups and individual employees to display and espouse particular characteristics such as loyalty, selflessness, honesty, objectivity, probity and integrity (Fisher & Lovell, 2006) According to Yeboah-Assiamah et al., (2016), ethics is about honesty, accountability, pursuit of excellence, loyalty, integrity and responsible citizenship Fisher and Lovell (2006) asserts that code of ethics do not on the whole address specific types of decisions; rather they encourage the application of what might be 'virtues' They seek to institute principles of right behaviour that may serve as guidelines for such conduct.” Therefore, whereas code of ethics is more general, code of conduct is usually specific. The IFA (2007, pg. 3) defines code of conduct as “principles, values, standards, or rules of behavior that guide the decisions, procedures and systems of an organization in a way that: contributes to the welfare of its key stakeholders; and respects the rights of all constituents affected by its operations”So defined, code of conduct identify specific acts that must be either adhered to, or avoided. They tend to be instructions, sets of rules or principles concerning behaviour and are reasonably prescriptive and proscriptive concerning particular aspects of employee behaviour (Cox 2015; Lentz 2014). 7 University of Ghana http://ugspace.ug.edu.gh “Fisher and Lovell (2006), aver that where all possible scenarios that employees might face can be predicted with a high degree of confidence, as well as all the circumstances relating to those scenarios, then a specific code of conduct might be possible, because ethical judgment becomes redundant However, in instances where the likely scenarios that an employee might face cannot be predicted in the requisite detail, then reference to general qualities and principles will be preferred, that is, code of ethics become more appropriate.” In this study, the meanings and usage of the two terms are not restricted in the sense that they all seek to stimulate good conduct among public officials. It must be noted that in the public administration literature, ethics has been very much discussed in relation to accountability and performance of public officials (Farazmand 2016; Lawson 2015). 2.3 The Concept of Culture Culture is an important concept that has been used to explain social and organizational outcomes in various disciplines (Baldwin et al., 2006). As a result, several definitions of culture are found in the literature. Pepitone &Triandis (1997) defined culture as “the shared meanings that are encoded into the norms that constitute culture” (p. 485). For Hofstede (1994), culture is “the collective programming of the mind which distinguishes the members of one category of people from another” (p. 1). On his part, Schein (2010) defined culture as “a pattern of shared basic assumptions that were learned by a group as it solves its problems of external adaptation and internal integration that has worked well enough to be considered valid and, therefore, to be taught to new members as the correct way to perceive, think, and feel in relation to those problems” (Schein, 2010 p.18). While these definitions highlight different aspects of culture, a central thread that seems to run through all of them is that culture represents the qualities possessed by a particular group of people that is passed on from one generation to another. Also 8 University of Ghana http://ugspace.ug.edu.gh consistent in the definitions, is the view that inherent in culture are norms and values that result from the taken-for-granted experiences which shapes the behaviour of individuals and groups overtime. 2.3.1 Levels of Culture Culture has been found to exist at different levels. According to Hofstede, Hofstede &Minkov (2005),culture can be at the individual family, society organizational and national levels. All these can exert profound influences on individuals and will therefore determine the extent to which codes of ethics are enforced in organizations. While the various levels are important for understanding the enforcement of codes of ethics, organizational culture, which refers to the formal and approved way of life exhibited by workers as expected and enforced by their organization (Asare-Bediako, 2000) is quite instructive. This is because code of ethics are usually instituted to ensure conformance to ethical standards within the organizational setting. Organizational culture involves the learning, transmission and acquisition of work-related attitudes, knowledge, beliefs, values and norms that constitute the way of life or established formal behavior pattern of workers over time (Adams 2017; Anitha 2016). Organizational culture provides a common set of assumptions, beliefs, and values that develop within an organization enabling it and its employees to cope with the external and internal environment. These sets of assumptions are passed on to new members to guide their actions with respect to these environments (Schein 1984). Ardichvili et al., (2009) identify two aspects of organizational culture; formal and informal. The formal organizational culture encompasses organizational core components such as leadership, 9 University of Ghana http://ugspace.ug.edu.gh structure, processes, policies, socialization mechanisms, reward systems, and decision making processes. The informal organizational culture on the other hand comprises behavior patterns that members are encouraged to follow, and they include factors such as peer behaviour and ethical norms (Kotter, 2008). These informal aspects are less visible and refer to the values that are shared by a group of people which prevail overtime. According to Anitha (2016), they are relatively difficult to change even when group membership change. Also, within a particular organizations culture, is ethical culture which is seen as the expression of broad patterns of implicit values, beliefs, and assumptions that define organizational settings and how they evolve overtime (Wittmer, 2016). Ethical organizational culture is the outcome of the linkage between formal programs, compliance-based ethics, and organizational cultures that embrace responsible conduct. These are important in shaping an organisational culture and setting the ethical policies of the organization. Reward and punishment systems, ethical codes are some of the useful strategies for whipping employees in line to behave ethically towards the achievement of organizational goals. Existing at the macro level is national culture which refers to Hofstede, (1984) described culture as a “mental program which contain components of national cultures” (p. 11). Hofstede (2001) perceived culture as infrared elements of a society that reside in peoples' minds, that which help to provide answers to identity-driven questions such as who people are and “where they belong” (p. 10). According to Hofstede (2017), these mental programs usually define differences in the prevailing values that are espoused among people from different countries. To advance knowledge in national culture studies, some scholars have done extensive empirical studies and developed various models to guide research and practice. These include Hofstede's dimensions of national cultures (Franke, Hofstede, &Bond, 1991; Hofstede, 1984; Hofstede, Hofstede, 10 University of Ghana http://ugspace.ug.edu.gh &Minkov, 2010), Schwartz’s theory of cultural values (Schwartz, 1992, 1994a, 1999), and recently the Global Leadership and Organizational Behavior Effectiveness (GLOBE) Research Program. All of these frameworks operate on the assumption that the national culture within which organizations exist have implications on the performance and behaviour of employees. For this study, these studies are relevant because they suggest that the extent to which the code of ethics are enforced depends on the national culture of the Ghanaian context. 2.4 Codes of Ethics and Ethical Conduct As has been hinted earlier on, code of ethics is a commonly used approach to ensure ethical conduct in organizations. The literature is replete with several theoretical and empirical evidence to the effect that codes of ethics can be used to ensure compliance to ethical practices (Adelstein& Clegg 2016; Frederickson 2015; Wittmer 2016). The research highlights several direct and indirect benefits of code of ethics for organizations such as: positive employee behaviour, management and corporate culture creation, and a positive impression among clients and stakeholders (Frederickson 2015). According to Gotterbarn (2018), code of ethics function to outline a profession's values and to present professionals' commitment to those values. In spite of the purported benefits however, it has also been found that the mere existence of code of ethics in organizations does not necessarily ensure ethical practices. Scholars have pointed to a myth reality gap between ethical codes and ethical behaviour, with some pointing to a complete lack of interest in or knowledge and understanding of this professional codes (Cameron & O’Leary 2015).Others focus on the challenges associated with organizational attempts at 11 University of Ghana http://ugspace.ug.edu.gh addressing poor work attitudes and transforming undesirable organizational culture through the implementation of otherwise good ethical policies for their organizations (Carter, 2015). The literature also identifies some general determinants of codes' efficacy. Ford and Richardson (1994) broadly divided the determinants into two groups—individual factors such as age, sex, nationality, etc. and those that are outcomes of the human development and socialization process such as personality, attitudes, values, education, religion, employment. These variables embody the sum of one's life experiences and circumstances that an individual brings to the ethical decision-making process (Ford and Richardson 1994). The situational factors include peer group influence, top management influence, organization size, and industry type. 2.5Factors Influencing the Enforcement of Code of ethics in Organizations The foregoing discussions underscore code of ethics as an important means of ensuring ethical behaviour of employees. While they remain a widely used approach, it has been found that establishment of ethics codes cannot be fully effective by themselves. According to Wachs (2017), because of their generality, codes of ethics, can only go as far as promoting ethical conduct in fulfillment of professional ethics. Instead, a number of other factors come to play to increase the efficacy of code of ethics. Driskill (2018),argues that whether or not a code of ethics will be effective depends on some three factors – whether employees know that a specific code exists; whether they understand the contents of the code and whether the enforcement of the code is supported by the work environment. General factors that determine the enforcement of code of ethics include; leadership support, organizational ethics factors, ethical climate, and the association between ethical behavior and career success in the organization and the general culture within which organizations function. 12 University of Ghana http://ugspace.ug.edu.gh 2.5.1 Leadership Leadership of an organization is one important factor that has been found to determine employees' ethical behaviour. The vast literature on ethical leadership provides insights into the extent to which organizational leadership can go to leverage ethical conduct and the image of their organizations (Demirtas & Akdogan, 2015; Shim et al., 2015). Hunt et al., (1984) originally developed a measure of “leadership support for ethical practices” and distilled three key means by which leadership impacts employees ethical conduct: (1) leaders serve as role models to encourage employees perform their own practices ethically and faultlessly (2) promote ethical practices by promptly reprimanding unethical conduct, and (3) develop and design ethics codes for their on organizations and the industry. According to Walumbwa, Hartnell&Misati (2017), ethical leaders stimulate ethical behaviour by assigning a strong value to organizational rules and procedures and that makes leadership action the single best predictor of ethical conduct in organizations. Hence, although organizations can put in place grand ethical codes to control employees' ethical behavior, it will take committed leadership to ensure that a more profound means is the value-based approach, where the leaders' own commitment to ethical behaviour, reward for ethical practice, and congruency between policies and actions—positively influences ethical behaviour among employees. 2.5.2 Organizational Ethics or Cultural factors An important factor that echoes very much in the literature as an influential factor of ethical behaviour is organizational culture (Driskill 2018). This role of organizational culture as earlier emphasized by Cassel et al. (1997) when they argued that “design and implementation of a code 13 University of Ghana http://ugspace.ug.edu.gh of ethics does not take place in a social vacuum and that the organizational context have a bearing upon how people respond to any code of ethics” (p. 1,080). In terms of ethical conduct, it has been found that while some cultures favour ethical conduct, others have been found to be either laxed enough to deter unethical conduct or actually support unethical conduct. Favorable organizational factors, such as top management support for ethical behavior, a favorable ethical climate, and a strong association between ethical practice and career success in the public service, can boost the impact of ethics codes on public relations professionals' behaviour. These favourable factors develop into an ethical climate that determines ethical conduct in organizations (Martin & Cullen 2006). Such a climate “the shared perception of how ethical issues should be addressed and what is ethically correct behaviour shapes According to Bedi et al (2017), an organization's ethical climate can result in four main outcomes for the employees—organizational commitment, job satisfaction, psychological well- being, and preventing unethical behaviour. For example, several studies have confirmed that a favourable ethical climate positively influences employee job satisfaction, potential promotion, and supervisors (e.g., Deshpande 1996; Okpara 2004). 2.5.3 Culture and Code of Ethics As has already been hinted, codes of ethics in organizations are not a result of individual or organizational factors but also, contextual and cultural factors for that matter (Knights & O’Leary, 2006; Meyers, 2004). Trevino (1990) observes that public organizations exist within cultures and a shared pattern of values, customs, practices and expectations which dominate normative behavior in the organization. 14 University of Ghana http://ugspace.ug.edu.gh In a study of ethical behaviour among public sector employees in Ghana and Kenya, Kuada provided empirical evidence of this reality of the sociocultural environment of Ghanaian and Kenyan cultural contexts and how this influences manager’s capacity to enforce ethical codes. Notable among these values and rules of behaviour are age and the culturally defined relationships between elderly and younger people of the society, status arrangements and power differences defined by social class attributes like positions, wealth and educational levels. Others include, familism, clanism and ethnicity and their practical manifestations in collective obligations as well as the disproportionate family burden on a few favourably placed family members; and metaphysical considerations, particularly ideas and philosophies of organized religions and traditional belief systems. Earlier on, Woode, (1986) had noted that the Ghanaian worker‘s hierarchy of loyalty is initially to his primary group, next to the extended family and then to the ethnic group. He/she considers it a moral obligation ―…to share the benefits of his/her employment helping family members, home town members, church members, old school mates, ethnic group members to obtain jobs, loans, and other favours from the organization (41-42). Employees trust, commitment and loyalty to the work group are sometimes heavily influenced by tribal and family considerations. The situation makes it difficult to obtain employee committed to the general mission and goals of the whole organization or its units. It also results in total disregard for ethical conduct in the civil service (Woode, 1986, pg.45). In a study conducted by the Institute of Chartered Accountants Ghana (ICAG, 2009), it was concluded that ethics of organizations are largely influenced by the existing political and sociocultural environment, and the Ghana‘s Civil Service is no exception. In this regard, the study identified ten common socio-cultural elements of the Ghanaian social environment which 15 University of Ghana http://ugspace.ug.edu.gh may influence the ethical orientations of employees, managers and leaders within Ghanaian organizations. They include: ―belief in the benevolence of the creator; extended family system; respect for elders; stress on achievement; authoritarian political structure; hospitality and gratitude; male dominated society and a show of masculinity; society dominated by communal values; and similar attitude to time (ICAG, 2009:25). 2.6 The Civil Service of Ghana The 1992 Constitution of Ghana in article 190 provides for a civil service as part of the broad public sector of Ghana. Established by both the 1992 Constitution and the Civil Service Act, 1993 (PNDCL 327), the Service has been defined as being at the core of government administrative machinery and the heartbeat government business. According to the Act, the Civil Service has: ―the object of assisting government in the formulation and implementation of government policies for the development of the country (Civil Service Law, 1993). It has overall responsibility of overseeing the business of most other services, each of which comes under a particular sector ministry. The sector ministries are by law required to ensure the efficient and effective performance of their sector Departments and Agencies. Under the Civil Service Law, 1993, the Civil Service performs a number of functions. These include initiating and formulating policy options for consideration of government; initiating and advising on government plans; undertaking such research as may be necessary for the effective implementation of government policies; implementing government policies; reviewing government policies and plans; monitoring, coordinating and evaluating government policies and plans; performing such other functions as are incidental or conducive to the achievement of the object specified in this law; and perform such other functions as the Executive may direct (Civil Service Law, 1993). 16 University of Ghana http://ugspace.ug.edu.gh 2.6.1 Civil Service Code of Ethics The quest for a Civil Service and public administrative machinery with the appropriate ethical disposition to deliver on its constitutional mandate and corporate goals has been pursued over the years. To this end, several administrative and institutional efforts have been made to establish a code of conduct for civil servants. There have also been several reforms of these codes of ethics (Ohemeng & Asiedu 2016). In 1999, the Office of the Head of Civil Service (OHCS) introduced a new Code of Ethics. The code is to provide an environment of new work ethics, values, attitudes and the required professionalism as part of a service-wide reform of the Ghana Civil Service. The code is in line with Ghana’s Vision 2020 which envisages a Public Administration System (PAS) driven by a market oriented, liberalized economy, operating in an environment of good governance. This expectation of the role of the PAS, calls for a Civil Service which is customer sensitive and ethically responsive in its dealings (OHCS, 1999:3) The code has been seen as a useful public sector policy initiative with the long term goal of transforming the image of the Civil Service. Ghana’s code of ethics emphasizes ethical conduct among civil servants. It defines conduct as behaviour, attitudes and character exhibited by anyone within and outside the working environment. Based on this definition, it outlines standards of conduct generally required of any member of the Civil Service to include; leadership, selflessness, competence, integrity, impartiality, fairness and honesty in matters affecting work and status in society ‘(OHCS, 1999:5). Despite its desire to ensure professional values such as effectiveness, probity, integrity and objectivity, the Civil Service has continued to exhibit negative images that tend to diminish its 17 University of Ghana http://ugspace.ug.edu.gh status and trust among members of the public. Civil Servants are perceived generally and often reported on by the media as corrupt, showing little commitment to their duties, lazy and largely exhibiting unprofessional attitude and ethically bankrupt in their dealings with clients. These tendencies raise questions as to the whether existing code of ethics are being effective after all. It also suggests that there may be some influences that may be constraining the effectiveness of these codes. It is in the search for such explanations that this study focuses on the cultural factors that influence the enforcement of codes of ethics at the MOH. 2.7 Theoretical Framework In understanding how culture influences the implementation of ethical standards at the MOH, this study will draw from Hofstede’s (2017) cultural dimension theory. The theory describes the effects of a society's culture on the values of its members, and how these values relate to conduct or behaviour of members. Hofstede’s theory has a fivefold typology: power distance, individualism/collectivism, uncertainty avoidance, masculinity/femininity, and long term orientation. First, power distance. This is the extent to which the less powerful members of institutions and organizations within a country expect and accept that power is distributed unequally. Hofstede argues that in an organization where there is large power distance, power is centralized as much as possible in a few hands: subordinates expect to be told what to do. The organization has “ a lot of supervisory personnel, structured into tall hierarchies of people reporting to each other. Salary systems show wide gaps between top and bottom in the organization” (Hofstede and Hofstede 2017:55). Subordinates usually accept power relations that are more authoritarian and paternalistic. Alternatively, with a small power distance, inequalities among people are 18 University of Ghana http://ugspace.ug.edu.gh minimized and the less educated people hold more authoritarian values than more educated persons. Second individualism versus collectivism. Individualism pertains to society in which the ties between individuals are loose: everyone is expected to look after himself or herself and his or her immediate family. Collectivism describes societies in which people, from birth onwards, are integrated into strong, cohesive groups. Throughout life, others in the group protect their own, but at the expense of unquestioned loyalty (Hofstede&Hofstede 2017 pg. 399-401). Third uncertainty avoidance. This is the extent to which members of a particular culture feel threatened by ambiguous or unknown situations. This dimension may be weak or strong. For instance, bureaucracies in cultures where there is great uncertainty will tend to create formal rules and believe in their correctness in order to reduce uncertainty. The bureaucrats resist change, new policies and so forth, and worry about the future. Whereas civil servants who work in weak-uncertainty countries tend to easily accept and even welcome new policies, in countries where uncertainty-avoidance is strong, it is common to respond with apathy and resistance and to reject new policies. Fourth masculinity verses femininity. Masculine culture stands for a society “in which emotional gender roles are distinct: men are supposed to be assertive, tough, and focused on material success; women are supposed to be more modest, tender, and concerned with the quality of life On the other hand, femininity stands for a society in which emotional gender roles overlap: Both men and women are supposed to be modest, tender and concerned with the quality of life.” Fifth “long term orientation verses short term orientation This dimension associates the connection of the past with the current and future actions/challenges Long term orientation 19 University of Ghana http://ugspace.ug.edu.gh stands for the fostering of virtues with a view towards future rewards, in particular perseverance and parsimony, persistence, ordering relationships and observing this order, and having a sense of shame On the other hand, short term orientation stands for the fostering of virtues related to the past and present, in particular, respect for tradition, personal steadiness and stability, ‘saving face’, reciprocation of greetings and favours, and fulfilling social obligations (Hofstede and Hofstede 20017:399-404) These dimensions and how they are characterized by Hofstede are summarized in the table below.” Table 2.1: Dimensions of Hofstede’s cultural theory Dimension Description “Power distance” “The extent to which people accept the unequal distribution of power in organization” “Individualism “The degree to which people in a society are integrated into groups Individualistic versus societies have loose ties that often only relates an individual to his/her immediate collectivism” family Collectivism, describes a society in which tightly-integrated relationships tie extended families and others into in-groups These in-groups are laced with undoubted loyalty and support each other when a conflict arises with another in- group.” “Masculinity “The extent to which men and women are perceived as equal in a society In high versus femininity” masculinity cultures, men and women have their own separate roles but in high femininity cultures, both genders are treated as equal and have similar roles.” “Uncertainty “The extent to which people in a society prefer structured/unstructured situations avoidance” Cultures high on this dimension emphasize laws and regulations and stiff codes of behaviour, guidelines. individuals here are less likely to take risks and accept change” “Long-term “This dimension focuses on the connection of the past with the current and future orientation versus actions/challenges Societies with a high degree in this index (long-term) view short-term adaptation and circumstantial, pragmatic problem-solving as a necessity A poor orientation” country that is short-term oriented usually has little to no economic development, while long-term oriented countries continue to develop to a point” Source: Hofstede(2017) 20 University of Ghana http://ugspace.ug.edu.gh Hofstede’s theory has implications for understanding how the general Ghanaian cultural context influences the implementation of codes of ethics because as suggested by Hofstede, organizational decisions taken to enforce ethical standards will be based on the country's customs and values. It highlights the interplay between social-cultural beliefs and values and the influences on organizational culture and ethical conduct of the Civil Service. Hofstede’s dimensions offer guidelines for defining culturally acceptable approaches to enforcing the codes of ethics in the MOH and the challenges that could be encountered because of the cultural milieu within which these codes are enforced. 21 University of Ghana http://ugspace.ug.edu.gh CHAPTER THREE METHODOLOGY 3.0 Introduction This chapter presents the research procedure that was used for carrying out this study. The chapter begins with a discussion of the adoption of the qualitative approach and the case study strategy and their appropriateness for the study. The chapter further discusses the population, and the purposive sampling procedure, as well as the semi structured interviews and document reviews as the main tools for data collection. There is also a discussion of how the data was managed and analyzed. The chapter ends with the ethical measures that are taken in the study. 3.1 Research Approach This study adopted the qualitative approach of social science research. The approach made it possible for the study to achieve it’s the underlying objective of seeking to understand how culture influences the enforcement of codes of conduct at the ministry. As noted by Creswell, (2014), qualitative approach is suitable for studies that seek understanding. This approach was therefore relevant because it made it possible for the researcher to understand the cultural influences that affects the implementation of code of ethics at the MOH, as well as how these cultural tendencies are managed from the perspectives of the officials themselves (Creswell 2014).The approach offered officials the opportunity to express themselves freely on the cultural undertones that come to bear on the enforcement of ethical standards at the MOH. 22 University of Ghana http://ugspace.ug.edu.gh 3.2 Case Study Design For qualitative studies, several designs were used. These include, case studies, ethnography and phenomenology (Braun & Clarke 2006). The choice of a particular design however depends on a study’s objectives and associated research questions. This study used the case study design, which best suited the objective of seeking to understand in-depth the cultural values and norms that influence the enforcement of code of ethics at the MOH (Yin, 2014; Patton, 2002). Bryman (2004) observes that case studies are concerned with issues that required an intensive examination of the setting. Hence, because of the nature of code of ethics and the need to understand the cultural contexts surrounding their enforcement, the case study design was appropriate. The design helped to examine the prevailing cultural influences and how they were managed within the bounded context of the ministry. Overall, the case study allows for an in-depth examination of the cultural norms surrounding the enforcement of ethical codes at the MOH and from the perspectives and experiences of civil servants themselves. 3.3 Study Organization The study organization for this study is the Ministry of Health (MOH). The ministry was chosen as the case unit from which individual civil servants are sampled and interviewed. MOH is one of the key ministries in Ghanaian charge of all health related issues and activities in the country. Per the establishing Act, the Ministry has the mandate to ensure good health in Ghana and reduce the negative impact of ill health on socio-economic development. It is responsible for managing Ghana's healthcare industry with specific functions such as, providing public health services, building hospitals, clinics and other medical facilities (MOH 2013). 23 University of Ghana http://ugspace.ug.edu.gh Hitherto, “the ministry was responsible for direct public health service delivery and provision in the country However, with the enactment of an ACT 525 of parliament, the functions of promotion, preventive, curative and rehabilitative care has been delegated to the Ghana Health Service and Teaching hospitals Hence, the ministry is currently responsible for only policy formulation, monitoring and evaluation, resource mobilization and regulation of the health service delivery in the country.” 3.4 Target Population Population in research refers to the “total collection of individuals or objects about whom a researcher intends to make specific conclusions” (Neuman, 2007 pg. 43). It refers to the group, usually with certain common characteristics, about which a researcher would like the results of a study to be generalized or related to. For this study, the target population includes all civil servants at the MOH because the conclusions drawn apply to all of them. 3.5 Sampling Technique The study used the purposive sampling technique to select the institution and respondents to be interviewed. The technique is used to select suitable officials best placed to answer my research questions; thus those who were deemed crucial to have the information needed (Abrams 2010; Palys 2008).The MOH and the headquarters in particular was purposively selected because as the ministry responsible for health, all doctors, nurses and other health professionals come under their control. For these professionals, ethics was an important issue and so were the codes of ethics, which was enforced by the ministry in addition to the specific professional codes of these professionals. The ministry therefore becomes a good test case to explore how cultural values in the Ghanaian context influence the enforcement of code of ethics. 24 University of Ghana http://ugspace.ug.edu.gh With the objective of seeking understanding, respondents were purposively selected. Specific officials connected with the enforcement of codes at the ministry are identified and interviewed because they had relevant information on the issue. Although officials were selected prior to fieldwork, (see subsection 3.6 below), the snowballing technique is also used to reach the most appropriate officials to respond to the research questions. 3.6 Sample Size The sample for this study is made up of two groups. The first group comprise of officials who were directly or indirectly responsible for the enforcement of code of ethics at the MOH. This group included HR officers, directors of development and management, monitoring and evaluation, and other senior officials in supervisory positions at the ministry. These officials were interviewed to pick their experiences on the cultural factors that come to play as they enforced the code of ethics among employees and how they manage them. The second group comprised lower level civil servants in the ministry, who were interviewed to pick their views on how cultural factors influence their adherence to ethical codes at the ministry. Overall, the 15 in depth interviews were conducted among officials of the MOH (see table 4.1) 3.7 Data Collection Sources “Data was collected from both primary and secondary sources The primary data was collected from in-depth interviews, while the secondary data was collected from a review of relevant documents including the code of ethics of the civil service, HR reports of the ministry, bulletins, policy briefs and disciplinary codes Other literature on culture and code of ethics from peer reviewed articles, books and other publications are also reviewed While the primary data provided new and empirical data from the field, the secondary data provided critical inputs in 25 University of Ghana http://ugspace.ug.edu.gh writing of the introductory chapter of the report The secondary data also helped to validate the primary data that was collected during fieldwork and in writing the analysis chapter.” 3.8 Data Collection Tools The main tools for collecting primary data in this study were interviews.Inna (1999 pg. 12), indicates “given their subjective nature of ethical issues, face to face interviews are one of the best techniques to elicit such information”. The use of interviews helped in interactions between the researcher and respondents in an effective manner that enhanced understanding of the cultural factors underlying the enforcement of code of ethics at the MOH. Again, considering the researcher’s objective of seeking understanding, the semi structured interview guides were used. This allowed respondents to share their experiences in an unrestricted manner, while affording the researcher the flexibility to follow up on interesting issues that emerged in the process. The interview guides were prepared along the study’s research questions and they gave the researcher the opportunity to scratch beyond the surface to have a deeper understanding of the underlying cultural values and norms in the Ghanaian context and how they influence the enforcement of ethical codes at the MOH. The interviews covered senior officials to gauge their experiences on the cultural tendencies as they try to enforce the code of ethics, and the challenges faced. Interviews were also extended to cover lower civil servants in understanding how culture facilitates or hinders their compliance to the code of ethics. Interviewing officials at the various levels in a semi-structured manner helped to elicit divergent views and corroborate responses to specific questions from different sources. It 26 University of Ghana http://ugspace.ug.edu.gh also provided opportunities for gaining interviewee-specific insights around the same set of research questions. 3.9 Data Management and Analysis The interviews in this study were recorded with a digital voice recorder. In addition, the researcher kept a research journal in which other field notes and informal chats will be written. After data collection, all the audio data were transcribed into text and subsequently edited to detect and eliminate typographical errors. The researcher then read the data over and over again to familiarize and to have an idea of what the data contained (Boateng, 2016). The thematic analysis approach was used to generate meaning from the raw data. This was done by first identifying important themes and patterns in text data through careful examination and constant comparison (Creswell 2014). After that themes emerging from the data were grouped under the main objectives of the study; thus the cultural factors influencing the enforcement of ethical codes at the MOH; how cultural factors influence the codes of ethics in the MOH and how these cultural tendencies are managed to ensure effective enforcement. The researcher then discussed the findings by relating them to the literature reviewed and Hofstede’s cultural theory to either validate or invalidate the major arguments. Specific quotes from respondents were cited where relevant to buttress the generated themes. New insights that emerged on how cultural norms influence the enforcement of ethical codes in the MOH were also distilled. 27 University of Ghana http://ugspace.ug.edu.gh 3.10Ethical Considerations This study was concerned with ethical issues at a Ministry therefore certain ethical principles were observed to protect the interest of the institution and individual respondents. Before conducting fieldwork, “an introductory letter was taken from the department of Public Administration and Health Services Management to seek entry to the ministry Also, before the commencement of interviews, respondents were assured that the use of information provided was for academic purposes only To ensure the anonymity of respondents, they were not be made to disclose their identity The researcher ensured that the information provided is kept in confidence for this study only Also, interviews were conducted with confidentiality and privacy at the convenience of respondents To conform to the University of Ghana’s rules and procedures on plagiarism, all sources of literature used for the study was duly acknowledged.” 28 University of Ghana http://ugspace.ug.edu.gh CHAPTER FOUR FINDINGS AND ANALYSIS 4.0 Introduction This chapter presented analysis of the data that was collected in response to the study’s research questions. The analysis was done by comparing the interview data with those obtained from company documents and other literature reviewed as well as the study’s theoretical framework. The qualitative content analysis was used to generate meaning from the raw data by identifying important themes and patterns in the text data through careful examination and constant comparison. The responses of the interviews were closely reflected upon to generate and define common themes for each objective, which were interpreted and synthesized with the literature by relating the findings with existing literature. The findings are presented in the form of narratives with selected extracts from interviewees so as to enrich and contextualize the discussion. Demographics Information of Respondents The respondents that were available for a successful collection of information can be categorized under senior, middle and junior level officials respectively. First senior level. The senior level officials comprise of the Deputy Director 1, Human Resource Director1, Assistant Director (Monitoring and Evaluation) 1, and Assistant Director (Staff Development)1 and Business Development Officer. Second middle level. This comprise of ICT officer 1, accountant1 and administrator 1 Finally junior level officials, this comprise of Administrative Assistant 1, Data Entry Level Officer3, Account Clerk 2 29 University of Ghana http://ugspace.ug.edu.gh Table 4.1: Breakdown of the demographics information of Respondents Source, Fieldwork data 2019 Number Years of Service Qualitative Interviews Position of respondent Senior level officials o Deputy Director 1 25 o HR Director 1 18 o Assistant Director, 1 30 Monitoring and Evaluation o Assistant Director; Staff 1 20 Development Middle Level Officials o Business Development 1 27 Officer o ICT Officer 1 10 o Accountant 1 10 o Administrator 1 12 Junior level o Administrative Assistant 2 2 employees o Data Entry officer 3 4 o Account Clerk 2 3 Total number of 15 officials 4.1 Cultural factors that influence enforcement of code of ethics at the MOH This theme sought to identify the cultural factors that influence the enforcement of code of ethics at the MOH. It sought to explore some of the important considerations that emanated from the cultural context of Ghana to influence the enforcement of code of ethics. Respondents identified a number of cultural factors that influence the enforcement of code of ethics. These include but 30 University of Ghana http://ugspace.ug.edu.gh not limited to, respect for age, gender, religion, obligations to family and other social activities like funerals, festivals, outdooring and the disregard for time. In the reckoning of respondents’ information, these factors are embedded in the Ghanaian cultural system and play an important role in the enforcement of code of ethics. Some officials noted that; “There are several cultural practices that impact on codes of ethics here. These include respect for age and attachment to family and other communal obligations as well as people respect for time, which affects punctuality to programs. These exert profound influences on the capacity of the ministry to enforce our codes of ethics” “People here work in groups. The clicks and connections makes it impossible to enforce the code of ethics. Infact when you punish someone, the next time you will also be the victim. Therefore, to survive here clicks works best” “Yes, the cultural behaviours of the employees and its tendencies affects work. The more you try to enforce the rules the more you are hated. So why enforce. They will find a way to frustrate you to leave enemy of progress and that’s the system here. This is much grounded and held sacred.” “To some extent people I work with are very connected and communal. Although the code of ethics is clear when a person violates it, the rules are not meted out fully thereby making the code of ethics ineffective in practice and reality” “Having learnt the details of the work and promotion comes steadily, am young but in a very powerful position. Now my older boss who taught me the details of the work violates the code of ethics who am I to punish him? This is a very pressing issue. The older people they always condone to wrong doing that is the norm. I can only advice and correct but I can’t apply the rules. Majority of the staff do not want to do the right things. Is a lifestyle here” 31 University of Ghana http://ugspace.ug.edu.gh These view suggested that cultural factors are influential on the extent to which code of ethics are enforced. As established earlier by Hope (2016), these cultural factors formed a web which entangles the public official and makes him unable to make a sound ethical judgment. From the data collection the most profound factors are ethnic groups or clans affiliations, respect for the aged and religion. 4.2 How cultural factors influence the enforcement of codes of ethics in the MOH Based on the cultural factors identified, the study outlined in a detailed manner the factors that influence the enforcement off code of ethics at the MOH which were but not limited to these factors: ethic group or family relations, respect for age and code of ethics, gender roles, religion, disregard for time, Dwaotoa, social activity engagements and leadership as discussed below: 4.2.1 Attachment to kinsmen; ethnic groups, clans and family relations An important cultural factor that was found to influence the enforcement of code of ethics at the MOH was expressed in employee’s attachment to various ethnic groups, clans and family groups. The interview data indicated that societal cultural values and expectations, rules and norms had explicit expectations on individuals to be sympathetic towards people of their own ethic group or family and clan and that impacts the enforcement of ethical codes. The study found out that this attachment has been a major constraint of the fair application of rules, regulations and codes, because in cases where one’s kinsman, clan member or tribesman is involved, the rules tend to be relaxed. According to respondents, this has led to selective application of the code. An official observed; “It is very common around here that people tend to coalesce around people from the same area or ethnic group. Although that is not bad, what it does is that it makes it difficult for people to 32 University of Ghana http://ugspace.ug.edu.gh apply the codes fairly when someone one from their group is affected. So when it comes to application of the code of ethics, they are soft towards people who belong to their ethnic groups” Another official explained how such attachments to ethnic groups, clans and family relations affects recruitments. He raised a number of pertinent questions in his submission; “Sometimes you are brought a tall list of people from your extended family that you are expected to help get into theministry. So the question is how you deny them the opportunity if you can help them, and what happens to those who are also qualified but don’t have anybody to help them? Are you being fair to them and what happens if every senior official has a list like that to deal with? That is the challenge that we are confronted with on a daily basis”. He further conceded; “When you are in public office you are sandwiched between sticking to your code of ethics in order to serve the public interest well and that of your own people too. So when you are presented with a case that requires you to be fair, sometimes against the wishes of your own people you are constrained. Such situations can take you months to resolve because although the code of ethics is clear you cannot just look on because after all they are your people” This showed that a civil servants relationship with his extended family and the larger community can go a long way to determine how the code of ethics was applied. As indicated the enforcement of code of ethics is embedded in the ideas and beliefs of people’s attachment to various family and community networks and that influences the application of the codes of ethics. It validates the study’s theoretical framework by Hofstede (2017) on collectivism that people are integrated into strong, cohesive groups and are socialized to protect their in group members. The Ghanaian culture is highly engrained in interdependence, interconnection and 33 University of Ghana http://ugspace.ug.edu.gh interrelationships, ethnic affiliations, and the issues of paternal and maternal bonding. The spirit of collectivism lays a strong emphasis on “we” is exhibited in all transactions and life encounters. Also it resonated with the arguments propelled in the literature by Woode 1968 the Ghanaian worker’s hierarchy of loyalty is initially to his primary group, next to the extended family and then to the ethic group. This moral obligation, loyalty and commitment served as an affront to the observance and the execution of the code of ethics to the core. 4.2.2 Respect for Age and code of ethics As has been noted earlier respect for age as found to be a major cultural influence on influence enforcement of code of ethics. This resonated with the Ghanaian orientation that old age comes with wisdom and that the views of the elderly always superseded that of the younger ones. At the MOH, this outlook plays out fully in the enforcement of code of ethics, where younger people were charged with the responsibility of enforcing the codes? What happened respect for age served as a barrier. Interviewees indicated that in the situation when a younger person wanted to enforce the law, he or she is branded as disrespectful. “Evidence from the interviews suggested that much has not been done to create the required level of awareness amongst employees about the code of ethics and the essence of ensuring responsible behavior” Respect for age served as a hindrance on how the code of ethics will be enforced successfully. An official argued; “The age factor is so influential particularly when a younger staff happens to be the one enforcing or monitoring the effectiveness of the code. In such cases, if someone who is much older is found culprit, the person has a challenge. This is because of the cultural orientation of 34 University of Ghana http://ugspace.ug.edu.gh that Ghanaian culture, which requires that we respect the aged,it becomes difficult to apply the rules. Another responded recalled; There are several cases where younger directors have had issues with the older ones here. Anytime they try to insist on what the code says, the old ones will come up with questions like ‘do you know my age;I have been here since. I am old enough to be your father ok….it really becomes difficult” These findings reflect how the cultural orientation of the Ghanaian regarding the aged can present tough challenges for the enforcement of code of ethics. It shows that the cultural programming of the Ghanaian can exert pressure beyond what codes of ethics and officials who enforce them can contain. This attitude as identified by Hofstede (2017) starts right from home. “Values are among the first things children learn—not consciously, but implicitly Development psychologists believe that by the age of 10, most children have their basic value system firmly in place, and after that age, changes are difficult to make Because they were acquired so early in our lives, many values remain unconscious to those who hold them Therefore, they cannot be discussed, nor can they be directly observed by outsiders They can only be inferred from the way people act under various circumstances”. Specifically, in the Ghanaian context parents are always right as well as adult when children try to be assertive or come out clearly regardless of how they do it they are regarded as disrespectful These same values as learnt from childhood travels with these children as they up up take leadership positions and now deal with the issue of respect for age once again in the context of work affecting the rules of the game –thus the application of the code of ethics to all regardless of age becomes a challenge. 35 University of Ghana http://ugspace.ug.edu.gh 4.2.2 Obligations to attend social activities and enforcement of code of ethics Another important cultural factor that influences the enforcement of ethical codes is the various social activities that employees are expected to perform. It was found that while the ministries’ code of ethics prescribed appropriate norms of conduct for all employees in the ministry, these were sometimes affected by the various social activities that employees are expected to attend as a result of the demands of the Ghanaian culture. These social activities include; funerals, outdooring, and other festivals which are an important part of the Ghanaian culture. To the extent that employees belong to families and communities, they are obliged to attend these programs sometimes in defiance of laid down rules and regulations. However, officials observed that while some employees were genuinely constrained to attend such programmes, others used them as excuses tobreak the code. An official argued; “The thing is that we are all Ghanaians and we are all obliged to attend these programmes. The codes are there and they specify clearly what someone should do when any of the social obligations comes up for them to attend to. People have to attend funerals in their hometowns during weekends and all of that. So sometimes they leave early on Fridays and some don’t even come until Tuesday or Wednesday. In such cases, you cannot insist on punishing someone whose mother dies for example, but sometimes, others go too far with these things” Another official opined; “Now during this Easter for example, I got people who left their offices without the proper permission and when I queried them, I got people saying that they are from Kwahu and it as their festival time, so they needed to attend. So in that sense festivals as a part of the Ghanaian culture affects the enforcement of code of ethics. I think that the challenge here is that to find 36 University of Ghana http://ugspace.ug.edu.gh the balance and go through the right procedure to be able to attend these programmes without breaking your code of ethics is pretty difficult”. These sentiments highlight the influence of cultural values on the enforcement of code of ethics. As can be seen they exert a lot of pressure on employees to find a balance between meeting their cultural obligations and the demands of their codes of conduct. For senior managers, the genuine obligations on people to attend such programmes sometimes constrain them from effectively enforcing laid down rules and regulations. As was articulated by the respondents, there are situations where even some directors has to bend the rules in order to satisfy the demands of the Ghanaian culture on employees. Although the code of ethics specified sanctions to be metted out to employees who had broken the rules, HR officers had to consider the cultural implications and let them off the hook. This is in affirmation with Hofstede (2017) on rituals. “Rituals are collective activities, technically superfluous in reaching desired ends, but which, within a culture, are considered as socially essential: they are therefore carried out for their own sake Ways of greeting and paying respect to others, social and religious ceremonies are examples Business and political meetings organized for seemingly rational reasons often serve mainly ritual purposes, like allowing the leaders to assert themselves At the end of the day rituals served as a hindrance with the enforcement of the code of ethics at the MOH.” 4.2.4 Ghanaian cultural outlook on gender roles and enforcement of codes of ethics The study also established that Ghanaian perceptions of gender roles as pertains to their culture tend to have some influence on the enforcement of code of ethics among public servants. Perceptions of women for instance as a weaker sex as found to affect strict enforcement because people are nurtured to be considerate towards women. Thus, supervisors and HR managers are unable to apply the laws to the letter when it concerns women. Also, women in supervisory 37 University of Ghana http://ugspace.ug.edu.gh positions who want to play fair and enforce the rules are branded negatively as hard, witches etc. these perceptions of gender roles therefore affects the enforcement of ethical codes. Male bias in the Ghanaian social structure consists of bias concerning gender roles, which means that some particular roles are reserved for men while others are for women. An official argued; “Yes, that also affects our ability to enforce the code of ethics. If the issue concerns a woman and you want to enforce the code to the letter, they will say, you should be lenient because she is a woman. But sometimes, they take advantage of being women to break the code of ethics and we are also constrained because of what people will say” A respondent shares her view; “It is because that is how we are brought up. Men are seen as the head of the home; they have the final say and are treated as such. This practice has been carried down to the work systems in such a way that male dominance prevails. So it is difficult when women are in that position where they are to enforce the code of ethics. You are challenged because if you are too strict, they say you are a witch and if you are too relaxed, they say women are weak and cannot be leaders. That is the problem”. These findings echo with the masculinity and feminity dimension of Hofstede’s cultural theory (2017) which highlights the extent to which men and women are perceived as equal in a society. As has been seen in this study in Ghana the masculine culture, dominates men and women have their own separate roles. Men are seen and respected as leaders because they are seen as tough more than women. 38 University of Ghana http://ugspace.ug.edu.gh 4.2.5 Religion and Enforcement of Code of ethics at the MOH Religion plays a key role in the Ghanaian society and culture. It permeates every aspect of the life of the Ghanaian and most people attach a lot of importance to it. The study found that the strong Ghanaian attachment to religious values are sometimes extended to the application of code of ethics among employees at the MOH. It was established that considerations over religious affiliations and status affected the treatment of offenders of the code of ethics and this subsequently affected the enforcement of ethical codes. A respondent pointed out; “Religion is influential in the enforcement of code of ethics. For example, sometimes you get people meeting in some of the offices and praying during working hours, especially in the mornings. Sometimes you also get Moslems going out every other hour that they are going to pray. The code is clear that civil servants should not engage in behavior or conduct that disrupts or interferes with work of other officers by such means as, congregating on verandas, or outside their offices. But in such cases, you can’t push too much because you know how Ghanaians are very much attached to their religion”. Another official gave more support to this view; “Even in attending to clients, when you see a reverend minister in the queue, you will have to let him or her jump the queue to attend to him even though we are expected to treat all our clients fairly. Sometimes too, you can have an employee who doubles as a pastor or leader of religious group.Their religious activities can conflict with their work or code of ethics as a civil servant but you can’t sanction them because of their religious status”. These views does not only underscore how important religion is to the general Ghanaian culture, but even more importantly, how it influences the enforcement of codes of ethics. People’s 39 University of Ghana http://ugspace.ug.edu.gh respect for religious leaders makes them accord them some leverage when it comes to enforcing the code and religious activities are sometimes allowed in the ministry even though it contravenes the code of ethics. 4.2.6 Disregard for Time The study found that a major challenge in the ministry relating to lateness to work and other programmes was also rooted in the Ghanaian concept of time. Emanating from the culture of Ghanaians that elders are the last to attend functions, it was established that this thinking also affects the attitude of some employees to reporting time for work and other programmes. The interviews showed that lateness and absenteeism as a very common problem facing the ministry and according to respondent’s people just attended programmes late because they thought they are seniors and they should come when the juniors are already seated. This has also trickled down to the junior officials who tend to come late to work. An official argued; “You know this thing about our culture where chiefs and the ‘big men’ are always the last to come in to programmes. That thinking is what underlies the lateness and absenteeism here. Most of the time, people want their junior officers to come before they arrive. That is a major source of the lateness and it is difficult to punish offenders when superiors also come late” This point is buttressed by another respondent; “.It is sad but that is the reality. People believe that you cannot attend a programme first if you are a superior. So as for lateness and absenteeism, it is a major problem because, leaders don’t set any good examples for their subordinates and so the moral basis to sanction people when they break the code on lateness is not there”. 40 University of Ghana http://ugspace.ug.edu.gh These findings demonstrated how elements in the Ghanaian culture impacts the enforcement of code of ethics at the ministry. It shows that in the effort to enforce the codes, several values and norms in the Ghanaian culture come to play. The Ghanaian orientation that officials must come in late affects the general attitude to time and the ability of superiors to sanction offenders. These findings are interesting but they also echo with earlier research. For example, they validate the views of Cassel et al. (2007) who argued that design and implementation of a code of ethics does take place in a social vacuum and that the social context has a bearing on how people respond to enforcement of code of ethics. As seen in this study, although code of ethics spelled out clear guidelines and sanctions for breaches, various cultural tendencies in the Ghanaian environment negatively influence compliance and the extent to which they can be enforced. 4.2.7 The Concept of “Dwantoa” and enforcement of code of ethics Another expression of the Ghanaian culture that rears its head in the enforcement of code of ethics at the MOH is the practice of “dwantoa” where employees who broke the sought pardon through a third party. “Dwantoa” is an institutional arrangement for seeking pardon by offenders in the traditional set up and it is an act of interceding on behalf of an offenders. Narratives from respondents revealed linkages between this system of pardon and the enforcement of code of ethics in the ministry. Respondents indicated that the practice of seeking refuge in a third party, usually a person of repute such as traditional leader, a kinsman of the superior officer is common with offenders of the code of ethics An official intimated; “…as for influence from friends and family and other people from your community, it is our headache. Even when someone has intentionally broken the law and is expected to be punished, the person goes to seek the help of someone you know or is influential to come and intercede on his or her behalf. Sometimes, it is your pastor or family head, or village chief. When such a 41 University of Ghana http://ugspace.ug.edu.gh person comes, you can’t disregard their plea but it weakens the enforcement of codes of ethics in the long run. This is making it extremely difficult for the service to enforce our ethical standards” An official shared a personal experience; “I was once sanctioned by my boss for bringing my baby to the office after my leave had expired. This was after he had warned me several times not to do it again because it is not allowed. On one occasion, there was nobody to take care of the baby so I brought her and she suspended me for a week. I went to see his wife to intervene for me and when she did, he pardoned me”. These insights reveal how cultural norms can impact the compliance and enforcement of laid down procedures and rules regulating behaviour of individuals in a formal organization. It showed that in enforcing code of ethics, there are situations where superiors had to bend the rules in order to satisfy the cultural demands at the expense of established organizational norms. As such, when someone acts contrary to any of the rules, the procedure for correction is not applied but cultural considerations take precedence. These findings indicate that in countries like Ghana where cultural values are deemed important, strict application of rules as stipulated by Max Weber (1968) on the characteristics of bureaucracy in his painting of the ideal bureaucracy is difficult. Buttressing this point further with Hofstede (2017) on the dimensions of culture, individualism verses collectivism Ghanaians are a collective body. The“we” culture effect is so obvious that people do not even want to take responsibility for anything unlike in Western cultureswho are individualistic by nature the “I” syndrome makes people deliberately conscious of their actions and actions because they will face the consequences alone. Thus this third party 42 University of Ghana http://ugspace.ug.edu.gh rule does not exist in Western cultures unlike Ghana. This eats into the rich fiber of employees adhering to the code of ethics. 4.3 Managing cultural influences to ensure effective implementation of code of ethics at the MOH Based on the previous questions which investigated the cultural factors and how they influence the enforcement of codes of ethics at the MOH this section deals with ho these cultural factors can be effectively managed. It explored strategies adopted by the enforcement officials for navigating their way around the cultural influences confronting the service. Various respondents were given the opportunity to proffer suggestions from their own experiences. The interviews brought up a number of interesting insights. These include; depersonalizing the enforcement of code of ethics, stringent application of the code of ethics irrespective of who it affects or is involved, a regular review of the code of ethics to be culturally sensitive to the needs of civil servants and ethical education for employees. These suggestions are discussed below. 4.3.1 Depersonalizing the enforcement of code of ethics The study established that a major strategy that was adopted by the ministry to deal with the cultural influences that come to bear on the enforcement of code of ethics has been the effort to separate the code of ethics from the officials enforcing them. Officials noted that they have tried to educate employees to understand that those who enforce the rules are not the rules and that they only do their jobs by enforcing them. They also expect all employees in the ministry to conduct themselves within the strictures of the code of ethics because no matter who is found culpable at any point in time, the laws will be enforced. An official noted; 43 University of Ghana http://ugspace.ug.edu.gh “We are aware of how these cultural tendencies hinder some of the supervisors from enforcing the code to the letter even when they want to do so. It is because we have not been wired to understand that those who implement the code are different from the codes themselves. So in our meetings and other sensitization programmes, we try to create some awareness in this key area” I think that is what we have not done well here, because in other jurisdictions, the codes are depersonalized and people understand that when they break the code, is the law that works and not the one enforcing it. Here, people blame the one enforcing it and say all sorts of things about you without even looking at the one who did wrong in the first place. If people are made to understand that the code of ethics is meant to ensure orderliness and appropriate behaviour, they will understand that it is for their good”. 4.3.2 Stringent application of the code of ethics irrespective of who it affects or involved Knowing very well how these cultural influences come to bear on the enforcement of code of ethics and the fact that some employees tend to take advantage of the cultural card to misconduct themselves, officials indicated that they have usually insisted on the application of the code irrespective of who is involved. According to respondents, this strategy helped them to water down the use of cultural values to undercut the effectiveness of code of ethics. An official argued; “…over the years we have tried to apply the code of ethics without recourse to who is affected. They are stringently applied sometimes to the displeasure of some employees but I think that is the way to go. You can’t just allow people to have their way with the rules” 44 University of Ghana http://ugspace.ug.edu.gh Another respondent noted; “If wewant to address these cultural challenges, every effort must be made to ensure strict enforcement and also have stiffer punishment for offenders. Enforcing the laws will send the right signal across the personnel and compel them to act ethically” These suggestions are consistent with those offered by Schiebel & Pochtrager (2016) that codes of conduct be reviewed every now and then to cater for new developments that present enforcement challenges for officials. This study agrees with Schiebel & Pochtrager (2016) study that codes have limited or no impact on employee behaviour due to cultural impediments. 4.3.3 Ethical Education for Employees of the Ministry Another way of enhancing the ability of the service to manage the cultural factors that influence the enforcement of ethical codes among civil servants is through ethical training. Officials called for the intensification of ethical education for employees to make them more compliant to code of ethics from time to time. In addition, they must be must be educated and sensitized on how to find the right balance between cultural demands and obligations of the civil service. “There is an urgent need for the review and intensification of the education of civil service employees. This review should seek to emphasize the service nature of the civil service and incorporate standards as contained in the code of ethics”. This suggestion also reverberates with Driskill 2018) who argues that whether or not the code will be effective is in three factors-whether employees know that the code exists, whether they understand the contents of the code and whether the enforcement of the code is supported by the work environment. When all these are fulfilled then we can say that ethical education has taken place. 45 University of Ghana http://ugspace.ug.edu.gh 4.3.4 Review of the code of ethics to be culturally sensitive to the needs of civil servants Finally, respondents suggested that the code of ethics for employees of the ministry be reviewed and realigned to the cultural needs of the Ghanaian. “You see these things are a part of the Ghanaian culture and no matter how strict you want to enforce the codes, employees will still find a way to satisfy these cultural demands, therefore the best way is for the code to be reviewed and made flexible enough to integrate the various cultural needs of the Ghanaian”. Another respondent argued; “I think the code as we have it now has not taken adequate consideration of the needs of the Ghanaian culture. We must not forget that code of ethics exist in a cultural context and so we must contextualize it to respond to the cultural needs of the employees”. 4.4 Conclusion This chapter presented the findings and analysis of the study. The chapter established that several cultural factors come to bear on the enforcement of codes of ethics at the MOH. These influences include, respect for age, gender, religion, the practice of seeking refuge in influential people to intercede on other behalf, (dwantoa),obligations to family and other social activities like funerals, festivals outdooring funerals and the Ghanaian concept of time. These findings mirror how the cultural orientation of the citizenry can impact the manner in which codes of ethics are enforced. The analysis shows that the enforcement of code of ethics as a way of dealing with unethical conduct by officials in the MOH is also subject to the cultural factors that pertain in the Ghanaian context. Four main conclusions drawn from the study are stated below: 46 University of Ghana http://ugspace.ug.edu.gh First, depersonalizing the enforcement of code of ethics. There must be a clear distinction between the enforcement of the code of ethics and the officials who enforce the code. The officials are just doing their job and must not be victimized for doing their job. Thus the codes of ethics are laid down policies that must be observed by all even the person enforcing the code. Therefore, no one is above the law. Second, stringent application of the code of ethics irrespective of who it affects or involved. The extent to which strict adherence to the code of ethics prevents employees from engaging in acts that are in contraction to the code. This serves as check and balance ensuring that the code of ethics are applied at all times. Violation of the code means facing the music. This will prevent future offenders. Third, ethical education for employees of the ministry. Education brings enlightenment. This will raise awareness clear doubts and myths from the minds of the employees helping them learn and apply the code of ethics in their everyday work related activities, life and beyond. Finally, review of the code of ethics to be culturally sensitive to the needs of civil servants but not compromising on morals. 47 University of Ghana http://ugspace.ug.edu.gh CHAPTER FIVE SUMMARY, CONCLUSION AND RECOMMENDATIONS 5.0 Introduction This chapter summarizes the entire study of how culture influences the enforcement of code of ethics at the MOH. The chapter consists of 3 parts namely introduction, literature review and methodology. Having analyzed and discussed the data in the previous chapter, the first part presents a summary of the study and its findings, the second part then presents the main conclusion drawn from the findings and then the final part makes recommendation based on the conclusion. 5.1 Summary of the Study In this section, relevant aspects of the study were summarized. The section is organized under the specific objectives for which this study was conducted, the methodological approach used and a summary of findings. The study’s primary objective was to investigate how culture influences the enforcement of code of ethics in the MOH. This objective was necessitated by a paucity of research on the factors that underlie the non-enforcement of code of ethics within the Ghanaian civil service. The specific objectives were to: determine the cultural factors that influence enforcement of ethical codes at the MOH; investigate how cultural factors influence the enforcement of codes of ethics in the MOH and; to understand how these cultural factors are managed at the MOH to ensure effective implementation of codes of ethics. By addressing these objectives, the study provides new empirical data and subsequent analysis to inform research, policy and practice. 48 University of Ghana http://ugspace.ug.edu.gh The study used the qualitative approach. The case study design option for qualitative research was deployed to examine the issues in depth. Primary data was collected by in-depth interviews with various civil servants from the ministry of health headquarters in Accra. Through a review of existing documents, reports and other scholarly publications, the primary data was effectively triangulated to enhance reliability and validity of findings. Analysis was done through the thematic process. The study validates existing literature on cultural influences on the enforcement of code of ethics in Ghana but also discovered new findings which are summarized in the following section. The findings are presented in accordance with the study’s objectives. 5.1.3 Summary of findings In response to the first objective of determining the cultural factors that influence enforcement of ethical codes at the MOH, a number of them were established. These include, respect for age, gender, religion, the practice of “dwantoa”; seeking refuge in influential people to intercede on other behalf, obligations to family and other social activities like funerals, festivals outdooring funerals and the Ghanaian concept of time. In managing these cultural influences on the enforcement of code of ethics at the ministry, officials adopted various strategies including ethical education for employees, reviewing codes of conduct to integrate cultural concerns of civil servants, strict enforcement of the code of ethics and stiffer and consistent punishment for offenders. 5.2 Conclusions On the basis of the findings, four main conclusions are drawn as stated below: First, the enforcement of code of ethics at the MOH is influenced by several cultural factors,these influences include, respect for age, gender, religion, the practice of “dwantoa”; 49 University of Ghana http://ugspace.ug.edu.gh seeking refuge in influential people to intercede on other behalf, obligations to family and other social activities like funerals, festivals outdooring funerals and the Ghanaian concept of time. Second, the various cultural strict adherence to rules and regulations make it difficult for people to practice their culture, which forms part of their values. Third, Employees should disassociate the code of ethics from the officials who enforce the code. This is because the officials are just employed to do their job as part of ensuring that the right things are done in the ministry. Finally, the study further concludes that, the enforcement of code of ethics depends of good leadership from senior officials at the ministry. As argued byWalumbwa, Hartnell&Misati (2017), ethical leaders stimulate ethical behaviour by assigning a strong value to organizational rules and procedures and that makes leadership action the single best predictor of ethical conduct in organizations. Hence, although organizations can put in place grand ethical codes to control employees' ethical behavior, it will take committed leadership to ensure that a more profound means is the value-based approach, where the leaders' own commitment to ethical behaviour, reward for ethical practice, and congruency between policies and actions—positively influences ethical behaviour among employees. It is therefore imperative for leaders to lead by examples. 5.3 Recommendations Based on the findings and analysis of the study as well as the conclusions drawn above, the study makes the following recommendations. First given that cultural influences are profound on civil servants and exert so much influence on their outlook, it is recommended that there should be a continuous aggressive cultural reorientation of civil servants one thics. This can be done through continuous training, 50 University of Ghana http://ugspace.ug.edu.gh workshops, durbars, staff retreats and conferences. There should be an all stakeholder involvement helping employees know how crucial the enforcement of code of ethics is and the role it plays in ensuring professionalism. Also suggestions on the way forward will be solicited from staff. Once they feel part of the decision making process they will wholeheartedly apply the selves to do things the right way. Second, the study further recommends stringent enforcement of code of ethics irrespective of who is concerned whether old or young, rich or poor weak or powerful. As was suggested by respondents, there should also be stiffer punishment for offenders to deter others. Violation of the code should attract appropriate punishment and reward for obedience. Also effective leadership as suggested by interviewees must reign supreme amongst the top hierarchy of public sector managements. This is because, the key to responsible behaviour is to ensure that bureaucrats practice what they preach. Again, employees should see officials who enforce the code of ethics as people employed to do their work. This is because the official is separate from the code. Once an employee violates the code it is fair that the appropriate sanctions are enforced. It’s the code that is working and the official is just performing his duty. Additionally, officials should have a patriotic spirit. When they love to do things right, fairly and equally to all, this will go a long way to reduce such cultural tendencies. Finally, it is recommended that code of ethics and cultural practices are worked out in a way that would ensure harmony in the public institutions. This is because by public official’s cultural disposition they are caught in a web of cultural expectations. Therefore, effective enforcement of code of ethics requires a sound balance between these codes and existing cultural norms. Code 51 University of Ghana http://ugspace.ug.edu.gh of ethics must therefore be reworked continuously to accommodate the cultural obligations that civil servants have to satisfy even as they serve the state. 52 University of Ghana http://ugspace.ug.edu.gh REFERENCES Adei, S., &Boachie-Danquah, Y. (2003). The civil service performance improvement programme (CSPIP) in Ghana: Lessons of experience. African Journal of Public Administration and Management, 14(1), 10-23. Adelstein, J., & Clegg, S. (2016). Code of ethics: A stratified vehicle for compliance. Journal of Business Ethics, 138(1), 53-66. Ahenkan, A., Afari, M. B., &Buabeng, T. (2018). Ethical Dilemma of Health Professionals in Ghana: Experiences of Doctors and Nurses at the Korle-Bu Teaching Hospital. African Journal of Management Research, 25, 29-44. Bawole, J. N., Hossain, F., Domfeh, K. A., Bukari, H. Z., &Sanyare, F. 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(2014).Case study research: Design and methods (5th ed.). Thousand Oaks, CA: Sage 56 University of Ghana http://ugspace.ug.edu.gh APPENDICES APPENDIX 1: INTERVIEW PROTOCOL UNIVERSITY OF GHANA BUSINESS SCHOOL DEPARTMENT OF PUBLIC ADMINISTRATION AND HEALTH SERVICES MANAGEMENT Interview Guide This guide is to collect data for my research on the topic “CULTURE AND ENFORCEMENT OF CODES OF ETHICS IN THE GHANAIAN CIVIL SERVICE: EXPERIENCES FROM THE HEAD OFFICE OF THE MINISTRY OF HEALTH (MOH)”, towards fulfilling the requirement for the award of MPA Degree at the University of Ghana, Legon. I humbly crave your indulgence to ask you a few questions on the topic. Please be assured that any information collected is solely for academic purposes and you are guaranteed strict confidentiality. SECTION A: Bio of Official 1. Gender……………………………….. 2. Number of years worked at the MOH/in this position.................... 3. Current Position: …………………………….……………… SECTION B: Cultural factors influencing the Enforcement of Code of Ethics in the MOH? 4. Tell me briefly about your codes of ethics. To what extent are they enforced? What are some of the challenges? 5. What factors influence the enforcement of codes of ethics in this ministry? 6. Are there cultural factors that come to bear on the enforcement of codes of ethics in this ministry? 7. To what extent do cultural tendencies like respect for the elderly, perceptions about women etc influence the enforcement of codes of conduct? 57 University of Ghana http://ugspace.ug.edu.gh SECTION C: How Cultural factors influence the Enforcement of Code of Ethics in the MOH? 8. In what ways do these cultural factors influence the enforcement of codes of ethics here? 9. How does respect for age, gender roles, respect for time, religion and other such tendencies influence the enforcement of codes of ethics? 10. How about employee obligations to family, and other social activities, like funerals, outdooring’s etc. How do they affect the enforcement of ethical codes? SECTION C: How cultural influences are managed in the MOH to ensure effective enforcement of code of ethics? 11. How are these cultural tendencies that come to bear on the enforcement of ethical codes managed? 12. Does the ministry have any laid down measures for handling these cultural tendencies that impinge on the enforcement of codes of ethics in the ministry? 13. From your own experience, how do you think these cultural tendencies be managed to ensure effective enforcement of code of ethics? 14. Any other views you want to share with me on the cultural influences on codes of ethics here at the ministry? 58